I don’t know more things that I do know. It’s a simple fact of being a nurse practitioner. Even the things that I do know or recognize, sometimes, it’s hard to recognize that I do, in fact, know what’s going on, because even the relatively “normal,” “easy” yeast infections or bacterial vaginosis-type things look a little bit different on everybody.
And then someone starts talking to me about a rash or a skin issue and my eyes just go ahead and glaze over, because I can guarantee you that I don’t know one thing about that.
One of my most used phrases has become, “Do you have a primary care provider? Because this is a little outside the scope of what we do here at this clinic.” or, “Dermatology/urology/OB/GYN/breast specialists are really the expert in this particular problem, let me find you some we recommend in the area.” Sometimes half of my job is funneling people into different specialties because while, yes, that rash is on your breast, I have no idea what it is.
I do see quite a fair amount of primary care where I work, mostly because most of my patients do not have a primary care provider. I’m it. I’m lucky that I did a rotation with a lovely family practice doc and got to see everything from acute psych disorders, to chronic headaches, lots of strep throat, and shingles and skin issues galore.
For the most part, I excel in knowing what I don’t know. In fact, I am an expert at not knowing. While I was growing up, from the time that I was a small child, all I can remember is being the girl with the answer. I was the Hermione Granger of every class. I was well-versed in hearing, “Anyone BUT M have the answer?”
I remember having a break-down as a 4th grader because I had gotten a D on a geography quiz that was insanely hard. What 4th grader can memorize all the rivers in the U.S? But still, I beat myself up about it. It must be some moral failing, on the part of my 9 year old self to not have memorized all those damned rivers. I had to have the answers.
I struggled significantly in nursing school, feeling scared to speak up or even talk to patients about their conditions because I might not know everything. Slowly but surely, through the midwifery portion of my program, I began to become more comfortable with taking risks. Raising my hand when I wasn’t totally sure. Being humble when corrected, grateful that someone else had the evidence on the tip of their tongue, and moving on instead of beating myself up (although, ask any of my close friends/partner/mother and you’ll know that this is an ongoing exercise)
Now that I’m in practice, I realize that every practitioner that I work with is an expert in Not Knowing. You keep up with the evidence, you follow the protocols, but sometimes, even after 20 years in practice, you just have to trust that your best (very educated) guess has to be good enough. This is simultaneously soothing and terrifying.
This weekend I was on my own in clinic with a trusty and experienced MA (medical assistant, my life-line for getting anything and everything done on a busy day), and I had a case where I had absolutely no idea what was going on.
My patient told me her symptoms, when they started, what it looked like, and I thought we were going one direction, when suddenly, none of it made sense, and I just had to have a look. I had no idea what it was, or what to do, I had never seen anything like it, and a deafening silence was filling the room.
So I broke it down. I’m a relatively new provider, I explained, trying to calm and reassure, and, honestly, this isn’t something I have seen before. I’m going to step out and call someone. I’ll be right back.
Instead of being terrified, or absolutely horrified that I obviously had no idea what I was looking at, she thanked me. She actually thanked me for telling her that I didn’t know, and that I was going to go ask someone else. I was flabbergasted. But I guess I would feel much better, if I had been in her shoes, and someone was open and honest with me about their not knowing. That they were going to find the person who did know.
So, I found the person who did know, we came up with a plan, and everyone was happy. I’m sure that when (definitely when) this happens to me again, I might not get a patient that is so understanding about me being an expert Not-Knower. But at least for now, I’m happily resting in the land of constant discovery, learning, and someday, I may even pick up a Ph.D in Not Knowing.